Provider Demographics
NPI:1508171562
Name:KIRKMAN, SHELLY SORTINA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:SORTINA
Last Name:KIRKMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:SHELLY
Other - Middle Name:ANN
Other - Last Name:SORTINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1504 AVENUE G
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3756
Mailing Address - Country:US
Mailing Address - Phone:504-348-2887
Mailing Address - Fax:504-348-2887
Practice Address - Street 1:1891 BARATARIA BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4203
Practice Address - Country:US
Practice Address - Phone:504-340-2211
Practice Address - Fax:504-340-0057
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist